The URL can be used to link to this page

Home My WebLink About16-142r' IDENTIFICATION NO.__�t — 1 - 1 (Office Use Only) �t rill Awa ' MIS®rill APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday- Friday) 410 East WashinKton Street Iowa City, lo"a 52240-1826 Failure to complete the "required" information will result in denial of the application (719) 356-5040 (3 19) 356-5497 FAX F'rst Middle Last r 1. Name (REQUIRED) �ok�'�f 3cLM y Lii-)tSCf}Wq r- 2. Address (REQUIRED) 3A5s 1-)A,C,I) nclt 3. Contact Information (REQUIRED) Email: Cell Phone (: All ritten communication sent via email) H-OW1e 35 0 4a. Driver's License expiration date (REQUIRED) -7-9-17 b. Taxicab Business Name (REQUIRED) _ M n cc U`S 5. Prior experience in transportation of passengers: CA-, oi5 V ['Gri f�-/ 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? 110 Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? nd Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? h O Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the-name(s.),, y DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report form available u ' 9 P ( pop request). -_a (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number f 2(o A C � (5 S issued on J21L f 5- expiring onI understand that if I falsely answer any questions in this application, that this application may be denied. I agr a that in making this application, I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to examine any and all records and documents relating to this application, and I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Title i�tle�5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant � � d I i e1A-d Date 9—y — i(p STATE OF IOWA ) COUNTY OF JOHNSON Subscribed and sworn to before me by Mk9 C 47 67 +,t Sr -1 Wn this I day of %kua LLS�'f Zhl\ n i I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Driver's licenseZl C7r�l/ Signature of Police Chief or designee S!A/12,C)/A Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. -- L/y/tit�G, J lif L� /�%�� Sign Lure of City Clerk or designee Date Office Use Only Approved application DCI report State certified driving record Website update aeWTMDRORADGEAPPL92014 mended Doc 07/2016 Adg. 3. 2016 v.12:56PM Div of Criminal Investigation No. 9655 P. 1/26 n6Ct� r•.uua/ooa STATE OF 101VA Criminal History Reco,>; d Check 0 Requegt Form To: Iowa Divisiuu of C riminol Cnvcstigaiion Support Operations, Bureau, V Floor 215 E. 7"' Streot Iles Moines, Iowa 50319 (515) 725-6066 (515) 725-6000 Fax 1 Aran'PtIll PQ6.'o an Inw. IJ41 " D...._..d DC1 Account Nomber: .le�- (inapplicable) Front: Cit' of Iowa C.ily City Clerks Office 410 E. S6raabinglon 9trc5 Iowa City, IA 52240 Phone: 319-356-5041 Fax: 374-356.5497 '~-- Last Name(mlIa"dalory) FirstNameOnanasmm Middle 1Vauae(regmn,ende) Date of Birth (m,datory) Gender (n,andaiory) Social Security Number (recommended) Waiver Jnfornwfion: without a signed walver fl'om the subject of tike reguasL a complete criminal history record may not be releasable, per Code of Iowa, Chapier 692.2. For coo lete criminal history record information, a: allowed by law, always oblaln a walver si'nature from like sub ect of there nest. Waiver ft elease: 1 hereby give remission for Oto aborerc4nesting orflzai to conduct an Iowa criminal history record check aiih u¢ Division of Criminal Investleation (DCI). Any crini;ml history data wrier iognj/, a that is maintained by thhe DCI may be reicased as allowed by law. g" —`_ Waiver ,rianaturC�IW" Iowa Criminal ltiistoxy FZeeord Check Results As of_ t;\'5 1� O , a search of the provided name and date of birth revealed: c' No Iowa Criminal History Record found with DCl El t Iowa Criminal History Record attached, DO # DCI initials__ I�r l 4J cn DCI -77 (OS/25110) Received Time Aug. 1. 2016 1 18PM N0,0668 (DCI Aso only) Iowa Department of Transportation i may /Mice rR Urrow survties (rtxi lice) X06 ,53 D2. PO Sox X3204, des Manes, 14 5D306 -9W4 515.244 9124 FA)C 515-239-183! 2108144 None VAL VAL Non -Excepted Intrastate None None Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Certified Abstract of Driving Record Inquiry Date: 8/112016 DLI ID#: 126AGO155(IA) Customer #: Name: Liittschwager, Class: C ID Stat us: Robert James Address: 3255 HASTINGS Audit #: 9604880 DL Status: AVE Issue Date: 12/01/2015 CDL status: City/ State: IOWA CITY, IA Expiration Date: 07/0 81201 7 CDL Cert Status: 522454022 Endorsements: P CDL Med Status: Mailing Address: 3255 HASTINGS Restrictions: Corrective Lenses, Restriction AVE No Air Brake Supplement: Equipped CMV, No Class A and B Passenger Vehicle Date of Birth: 7/8/1962 Mailing IOWA CITY, IA Sex: M City/ State: 522454022 History Information 2108144 None VAL VAL Non -Excepted Intrastate None None Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 08/30/2014 1814875 IA Name: Liittschwager, Robert James DL/ID: 126AC0155 Pursuant to Iowa Code §321.10, 1, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is a true I" accurate Dopy of an official record currently in the custody of said Office, and that I have been authorized by the Director of thiPlowa Department of Transportation to so certify. i In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, -,at Ankeny, Iowa this date: v`'RMI 8/ 112016 -